Get Smart

The more you read, watch and hear about pregnancy, the more confused and overwhelmed you're likely to become. We're here to help, with expert advice on the only 10 things you really need to do to have a healthy pregnancy and baby.

1. Plan if you can "Start getting healthy even before you become pregnant," advises Siobhan Dolan, M.D., M.P.H., associate medical director of the March of Dimes. (Already pregnant? Just do all these things as early as possible, and try not to worry.) On your must-do-first list: Begin taking a daily multivitamin with at least 400 micrograms of folic acid, a B vitamin that helps prevent certain neural-tube defects, such as spina bifida; quit smoking, drinking alcohol or using recreational drugs; and see your dentist.

Schedule a pre-conception checkup, too. "Even before pregnancy, it is important to get any existing medical conditions, such as diabetes, high blood pressure and eating disorders, under control," says Jose Cordero, M.D., M.P.H., director of the U.S. Centers for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities. Have your doctor review your medications (prescription and over-the-counter) for pregnancy safety; for example, the acne drug Accutane is linked to severe birth defects. Also ask your doctor to test you for sexually transmitted diseases such as herpes or chlamydia that could harm your baby; make sure your immunizations are up-to-date (especially chickenpox and rubella); and have any infections or chronic health problems properly treated.

If you're over- or underweight, try to get into the normal range (more about weight later). And if you think you might be pregnant, avoid saunas and hot tubs; overheating during early pregnancy has been linked to birth defects.

2. Find the right caregiver "Choose someone who respects you and sees birth as a healthy process and not a disease," says Raymond De Vries, Ph.D., president of Lamaze International and member of the Bioethics Program at the University of Michigan Medical School.

Your best choice is an OB-GYN or midwife with excellent credentials who also respects your opinions and choices. If your pregnancy has been deemed "low-risk," selecting a family practitioner with obstetrical training or a certified nurse-midwife affiliated with an obstetric practice may lower your chances of having labor induced or undergoing a C-section. "Good research shows that using a midwife in an out-of-hospital setting can be as safe as giving birth with an obstetrician in a hospital, with fewer interventions and a more satisfying experience," says Tonya Jamois, president of the International Cesarean Awareness Network.

However, if your pregnancy is considered high-risk because you're expecting multiples, you've experienced previous pregnancy or delivery complications, or you've been diagnosed with certain medical conditions, including diabetes, obesity or high blood pressure, being cared for by an OB-GYN or a maternal-fetal specialist is crucial.

3. Watch the weight gain Women who gain either too little or too much weight during pregnancy are at increased risk for preterm delivery, regardless of their weight before pregnancy. Overweight moms are at greater risk, too, for pregnancy complications, including gestational diabetes, high blood pressure and preeclampsia. They're also more likely to give birth to larger babies, go through more complicated labors, and have C-sections, and are more prone to surgical complications when having them.

Current guidelines call for women of normal weight to gain 25 to 35 pounds, underweight women up to 40 pounds, and overweight women 15 to 25 pounds. But in light of the obesity epidemic, some experts are questioning the latter recommendation. "Research is showing that most women gain too much weight during pregnancy," says Raul Artal, M.D., chairman of the department of obstetrics, gynecology and women's health at Saint Louis University. "If you're overweight or obese [to start], be careful not to gain too much weight, if any." Ask your doctor what's right for you.

Pregnancy is not the time to diet, either, so don't stop eating or start skipping meals as your weight increases. "Restricting calories and other nutrients can lead to stunted growth and slow development of your baby, and a host of problems whenhe is born," says Heather Blazier, R.D., L.D., a clinical dietitian at the Medical College of Georgia in Augusta. But do cut out empty junk-food calories.

4. Surround yourself with support Practical and emotional support can be crucial in helping you stay healthy and avoid prenatal anxiety and depression, both common but underreported problems. Your circle could include your partner, family members, friends and co-workers, a childbirth instructor and fellow students, a La Leche League leader, your doctor or midwife, and the doula you hire to help you through labor, delivery and afterward.

Continuous support during labor has been shown to lower a mother's need for pain medication and her risk for interventions, including C-sections, and to lead to a more satisfying delivery. "It's important to have a sympathetic caregiver, but also to seek the support of friends or childbirth groups as a way of lowering stress, preventing isolation and dealing with depression during and after pregnancy," says U.S. Surgeon General Richard Carmona, M.D., M.P.H., F.A.C.S.

5. Know the red flags During pregnancy, seemingly mild symptoms may signal something serious, so never be embarrassed about calling your doctor if anything is worrisome. That includes persistent dizziness, fainting, shortness of breath, rapid heartbeat, constant nausea and vomiting, trouble walking, pain or burning during urination, blurry vision, pronounced swelling or decreased fetal activity for more than 24 hours. "About one in every eight babies is born prematurely, so contact your care provider immediately if you havesuch symptoms as uterine cramping that gets stronger, gripping backache, leaking amniotic fluid and vaginal bleeding,"says March of Dimes medical director Nancy Green, M.D.

Unless you're sure that you've had German measles or chickenpox or have been immunized against them, schedule a blood test to find out. Also get a flu shot and regular dental checkups (skip the X-rays, though); untreated gum infections are linked to premature births.

If you get sick, don't self-medicate: Even over-the-counter medicines such as aspirin as well as some "natural" and herbal remedies can be risky. Don't take anything that hasn't been OK'd by your doctor or midwife. (To find out if any substance you're considering taking or using is linked to birth defects, go to otispregnancy.org.)

6. Eat well (but not for two) Pregnancy is the time to make every calorie count. "Choose foods rich in nutrients such as protein, folate, calcium and iron that will nourish you and your baby," says dietitian Heather Blazier. High-fiber foods, including fruits, vegetables and whole gains, can help prevent constipation, a common problem during pregnancy. So can drinking plenty of water, which you also need to support your increased blood volume. Eating four or five mini-meals a day can help prevent heartburn and keep your blood-sugar (and, thus, energy) levels steady and prevent bingeing.

Avoid foods that can be dangerous during pregnancy, including undercooked meats, cold cuts and deli meats; raw fish and oysters; raw or undercooked eggs; and large fish, such as shark, marlin, swordfish and tuna, which can contain high levels of mercury and other toxins. Limit your caffeine consumption to 150 milligrams daily, the equivalent of about 1 1/2 cups of coffee.

7. Stay safe "Injuries are the leading cause of maternal death during pregnancy," says Andrea Carlson Gielen, Sc.D., Sc.M., director of the Center for Injury Research and Policy at Johns Hopkins Bloomberg School of Public Health in Baltimore. Motor vehicle crashes are the most frequent cause of traumatic injury to pregnant women, and in a crash, those who aren't wearing seat belts are three times as likely to lose their baby as those who are buckled up. Adjust the lap belt across your hip-pelvis area and below your belly.

"The second most common source of traumatic injury in pregnancy is domestic violence," Gielen says. A recent Harvard study found that women who experienced violence from their male partners during their pregnancies were 37 percent more likely to deliver their babies early, and their babies had a more than 30 percent greater likelihood of requiring intensive care after birth. Women who are being abused can call the National Domestic Violence Hotline for help (800-799-SAFE).

8. Get off your butt According to the American College of Obstetricians and Gynecologists, unless they have medical reasons not to, all pregnant women should exercise a minimum of 30minutes a day, six or seven days a week. "The good news is that this amount of exercise can be done in small increments--for example, three 10-minute segments when morning sickness or pregnancy fatigue is high," says Cincinnati-based exercise physiologist Renee M. Jeffreys, M.S., co-author with OB-GYN Karen Nordahl, M.D., of Fit to Deliver: An Innovative Prenatal and Postpartum Fitness Program (Hartley & Marks, 2005).

"There are numerous emotional and physiological benefits to exercising when you're pregnant," explains Nordahl, a clinical associate instructor in the Department of Family Practice at the University of British Columbia. "You'll probably feel more energized; you'll tend to sleep better; and your day-to-day activities won't seem as difficult if you're fit."

Regular stretching and exercise also can relieve backaches, constipation and morning sickness. Plus, having a strong heart and lungs will help you get through your upcoming marathon: giving birth. Low-impact activities, such as walking, swimming, prenatal yoga and Pilates, mild aerobics and stretching, are best, as are abdominal exercises.

However you choose to keep moving, avoid overheating, drink plenty of water and stop exercising immediately if you feel nauseous, weak or faint or get muscle cramps.

9. Go green The fetus is very vulnerable to environmental toxins, so minimize your exposure to chemicals, including those in commonly used household cleaners, pesticides, solvents and paints. Avoid lead dust, which can be generated during sanding and renovations in older homes.

"The most important pollutant for pregnant women to avoid is secondhand smoke," says Norman H. Edelman, M.D., chief medical officer for the American Lung Association. "It can cause your baby to be born smaller or prematurely, and might predispose him to asthma."

Exposure to high levels of carbon monoxide during pregnancy is also linked to prematurity and low birth weight, as well as to birth defects such as cleft palate--and even infant death. "Install carbon monoxide detectors in your home and make sure your furnace is working properly," advises Edelman. "And don't exercise during a smog alert, or exercise early in the morning, when smog levels tend to be lower."

Avoid cat litter and gardening soil; both can harbor the microorganism that causes toxoplasmosis, an infection that may cause serious harm to your baby. Also avoid direct contact with the urine and feces of rodents.

Buy organic foods if you can to minimize exposure to pesticides, growth hormones and other chemicals, and wash all fruits and vegetables before you eat them.

10. Try to stay calm "Laugh often, learn all you can about normal birth and stay away from people with scary birth stories," advises Marian Tompson, co-founder of La Leche League International and the mother of seven.

Some studies suggest that experiencing severe or chronic stress, such as being in an unhappy marriage, having a very demanding job or serious illness, or being in an accident, may affect the fetus. "Severe stress may affect your baby's growth and increase the risk of delivering prematurely," says Janet Rich-Edwards, D.Sc., an assistant professor of medicine at Harvard Medical School. "One out of 10 women experiences depression during pregnancy," Rich-Edwards adds, "and many suffer without seeking the treatment that could help."

Intimacy is a great stress reliever, and new research from the Ohio State University Medical Center confirms that unless you have risk factors for premature labor or other complications, you can enjoy a healthy sex life to the end.

3 Things You Don't Need To Do

• Worry about that drink you had before you missed your period. It takes about seven days for the fertilized egg (zygote) to travel through your fallopian tube and implant in your uterus. The placenta begins to develop at about 12 days after conception, which is just before your period is due. Before then, there's no exchange of blood between mother and baby.

• Worry that having morning sickness will rob your baby of nutrients. Generally, nausea and vomiting taper off by the end of the first trimester. During much of that time, the embryo and, later, the fetus will leech what it needs (which isn't a lot) from your body. Just make sure to take a multivitamin containing at least 400 micrograms of folic acid daily.

• Worry that something you do will cause a miscarriage. Most early miscarriages are the result of chromosomal abnormalities within the developing embryo; many occur even before you know you've conceived. Smoking, drug use and very heavy caffeine consumption increase miscarriage risk, but normal activities, including exercise and sexual intercourse, do not. Once the fetus's heartbeat is detected by ultrasound--usually at around six weeks of pregnancy (counting from the first day of your last menstrual period)--the risk of miscarriage drops to less than 10 percent.